Credentialing Specialist II

Department: Credentialing
Full-Time
Brentwood, TN or Hybrid

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Position Summary

Responsible for supporting the initial credentialing responsibilities of assigned established and new accounts to include submitting a complete application timely to our hospital partners, preparing state collaborative documentation for advanced practitioners and monitoring licensing application process.  Ensures providers are privileged in a timely and in an efficient manner. Follows established Standard Operating Procedures (SOP’s); notifications; reference guides; policies and procedures, etc.   

Primary Duties and Responsibilities:

  • 15%: Facilitates the pre-filling; sending and receiving of accurate and complete credentialing information; tracks and reports progress and performs follow-up activities as needed until provider file is complete and provider is awarded privileges.
  • 15%: Reviews the documents collected during onboarding to confirm they meet state, federal, and hospital partner requirements to include a current state license, CSR (if required), and DEA certificates to practice in contracted states.
  • 15%: Validates and verifies data entered in the credentialing database to ensure accurate and comprehensive.
  • 15%: Partners with credentialing leadership to ensure successful launches of new accounts in assigned territory.
  • 10%: Ensures timely issue of COI and enrollment in any state patient compensation funds through completion of the insurance application for all assigned providers.
  • 10%: Prepares and submits state collaborative documentation for advanced practitioners and ensures continuous compliance with the state.
  • 5%: Coordinates the license, CSR, and DEA requests with the third-party service and monitors from initiating the request to issuance of the credentials.
  • 5%: Escalate concerns regarding the licensing, state collaboratives, and privileging of providers and non-response to management.
  • 5%: Travels periodically to assigned facilities to build and maintain positive working relationships with APP hospital MSOs.
  • 5%: All other duties as assigned

Knowledge/Education & Experience Required:

  • High school diploma or equivalent required
  • Bachelor’s degree preferred
  • 3-5 years of relevant credentialing experience required
  • Certified Provider Credentialing Specialist (CPCS) preferred

Skills Required:

  • Basic computer and keyboarding skills required
  • Research and analyze data to support decision making
  • Strong verbal and written communication skills required
  • Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources

Abilities Required:

  • Ability to handle and maintain secure files containing sensitive personal information
  • Ability to organize and prioritize work and manage multiple priorities
  • Ability to work independently with minimal supervision
  • Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
  • Ability to follow established work-flows; standard operating procedures and corporate policies and procedures
  • Ability to follow established work-flows; standard operating procedures and corporate policies and procedures
  • Ability to serve as company representative

Physical Demands/Requirements:

  • Continuously sitting
  • Frequent walking, standing, bending, kneeling, and reaching
  • Continuous repetitive use of arms, hands and fingers
  • Occasional lifting and carrying up to 20 pounds

Mental Demands/Requirements:

  • High level of mental awareness
  • High level of attention to detail

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Note: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

*INTERNAL CANDIDATES: To be considered for an open position, you must be in good standing (i.e., not on a Performance Improvement Plan) and in your current position for at least six months. You must also meet the minimum requirements for the job and be able to perform the essential functions of the position.